A nurse manager is implementing a quality improvement project to reduce the number of methicillin-resistant Staphylococcus aureus (MRSA) infections at the facility. Which of the following actions should the nurse manager take first?

Near miss:

• Incident Report 1: The nurse identified the client's allergy before administering azithromycin, preventing an adverse reaction. Holding the medication and notifying the provider ensured patient safety, making this a near miss rather than an adverse event.

Adverse Event:

• Incident Report 2: The client did not receive prescribed prophylactic antibiotics during labor, leading to neonatal sepsis. The lack of antibiotic administration increased the risk of serious complications, making this an adverse event with potential long-term consequences.

• Incident Report 3: A tenfold dosing error led to the administration of 60 units instead of 6 units of insulin, resulting in severe hypoglycemia and unresponsiveness. This critical medication error placed the client at significant risk for neurological damage or death, classifying it as an adverse event.

• Incident Report 4: A critically low platelet value was reported but not communicated to the provider, delaying intervention and leading to a coma. The failure to act on critical lab results contributed to a preventable deterioration in the client’s condition, making this an adverse event.

• Incident Report 5: Despite being identified as a fall risk, the client sustained a fall due to a malfunctioning call bell, leading to an injury. The failure to address the defective equipment compromised patient safety, making this an adverse event that could have been prevented.

A. Identify the client's current health needs: Assessing the client’s history and physical condition allows the case manager to determine immediate health needs. This step ensures that care planning is based on the client’s specific symptoms, disease progression, and required interventions. Identifying health priorities first helps guide appropriate referrals and treatment decisions.

B. Call the provider with a list of client concerns: While communicating concerns to the provider is important, it should be done after identifying the client’s specific health needs. This approach ensures that discussions with the provider are focused and relevant. Without a clear assessment of needs, the information provided may be incomplete or unstructured.

C. Compile a list of community resources for the client: Community resources can support long-term COPD management, but they should be tailored to the client’s identified needs. The case manager must first assess what resources will be beneficial. Providing resources without understanding the client’s priorities may lead to ineffective or unnecessary recommendations.

D. Refer the client to a COPD support group: Support groups can provide valuable education and emotional support, but referrals should be based on the client’s preferences and readiness. Identifying health needs is the priority before making specific referrals. Ensuring that the client is open to and will benefit from a support group enhances the effectiveness of the referral.